Medical Scheme jobs in Good Hope, Western Cape
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View similar jobs with this employerMelomed Private Hospitals SAWestern Cape- Resolve patient and medical aid scheme queries.
- Interact with patients and medical aid schemes.
- Hospital or Medical Aid scheme case management would be an…
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- Medway MarketingCity Bowl, Western Cape
- Financial services or the medical scheme industry.
- Matric (Grade 12) and at least 8 years’ experience in financial services or the medical scheme industry.
- NMICape Town, Western Cape
- Employee referral scheme with generous financial reward.
- Annual bonus scheme (dependent on company and individual performance).
- Good enough isn't enough.
- Sonata OneCape Town, Western Cape
- Fund managers can raise capital faster at a lower cost from a wider pool of pre-approved investors.
- Sonata One is seeking an experienced MLRO to ensure robust…
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- WorkabilityCape Town, Western Cape
- Experience in healthcare, rehabilitation, medical schemes, managed care, or patient engagement.
- Contract Period:* 1 December 2026 to 31 May 2027 (six months).
- Melomed Private Hospitals SASouthern Suburbs, Western Cape
- Control outstanding medical aid accounts by processing and submitting all medical aid claims within the required time frame.
- Sonata OneCape Town, Western Cape
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- MRI SoftwareCape Town, Western Cape
- You’ll work closely with Consultants, Project Managers and subject matter experts to turn complex information into clear, engaging and professionally structured…
- SolventumWestern Cape
- Private medical sector experience and qualification in Advanced Wound care or Negative Pressure Wound Therapy ideally.
- Remote (must be based in Western cape).
- Sonata OneCape Town, Western Cape
- Fund managers can raise capital faster at a lower cost from a wider pool of pre-approved investors.
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- AstraZenecaCape Town, Western Cape
- At private sector may be required to handle basic managed healthcare (medical aid scheme) discussions at the doctor’s practice.
- The Rank Group PlcCape Town, Western Cape
- From pensions to bonus schemes, and private medical insurance to life insurance – we've got you covered.
- Operating with a multi-branded strategy, we offer…
- The Rank Group PlcCape Town, Western Cape
- From pensions to bonus schemes, and private medical insurance to life insurance – we've got you covered.
- Operating with a multi-branded strategy, we offer…
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- The Rank Group PlcCape Town, Western Cape
- From pensions to bonus schemes, and private medical insurance to life insurance – we've got you covered.
- Operating with a multi-branded strategy, we offer…
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- MRI SoftwareCape Town, Western Cape
- As the PMO Manager, you will be responsible for leading and developing the global PMO function across the Professional Services organisation, ensuring the…
Job Post Details
Case Manager
Job details
Pay information not provided
Full-time
Western Cape
Full job description
- Assess patient conditions and needs to develop appropriate care plans
- Interact with patients and medical aid schemes
- Resolve patient and medical aid scheme queries
- Update all information timeously and accurately
- CPT and ICD coding
- Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
- Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
- Maintain a control system that ensures the systematic monitoring of managed care patients
- Handling patient queries
- Update hospital information
- Qualified Registered Nurse
- Minimum 3 years nursing experience in a multidisciplinary hospital.
- Experience and exposure in Theatre and/or ICU would be advantageous
- Hospital or Medical Aid scheme case management would be an advantage.
- Experience in ICD 10 and CPT coding is essential
- Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
- Excellent communication skills (written and spoken)
- Excellent analytical and problem-solving skills
- Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
- Attention to detail
- Ability to cope well under pressure
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